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    您的位置:首頁 > 萬方期刊網 > 論文分類> 腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥的效果評估及分析

    腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥的效果評估及分析

    來源:萬方期刊網  時間:2018-04-16 11:20:26  點擊:

      湖南省常德市血吸蟲病防治院 415000

      【摘 要】目的:研究腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥的效果。方法:試驗對象:我院近2年收治的85例病毒性肝炎高膽紅素血癥患者。患者分組方法:分層隨機化法。85例患者分為常規組和試驗組兩個組別。常規組給予茵梔黃治療,茵梔黃30ml+250ml生理鹽水,1次/日;試驗組改用腺苷蛋氨酸治療,1000mg腺苷蛋氨酸+100ml生理鹽水微泵注射,1天1次。觀察指標:①總有效率;②治療前和治療后患者肝功能TBIL、AST、ALT的差異。結果:①試驗組相比于常規組總有效率更高,P<0.05;②治療前兩組肝功能TBIL、AST、ALT相似,P>0.05;治療后試驗組相比于常規組肝功能TBIL、AST、ALT改善更顯著,P<0.05。結論:腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥的效果確切,可有效改善患者肝功能,臨床可推廣使用。

      【關鍵詞】腺苷蛋氨酸;病毒性肝炎;高膽紅素血癥;效果

      Abstract:objective:to study the adenosine methionine effect for the treatment of viral hepatitis high blood bilirubin.Methods:the test object:our nearly 2 years treated 85 cases of viral hepatitis patients with high blood bilirubin.Patients grouping methods:stratified randomization.85 patients were divided into normal group and experimental group two groups.Group was given conventional Zhi yellow treatment,yellow wormwood Zhi 30 ml + 250 ml saline,1 time/day;Experimental group using adenosine methionine treatment,1000 mg of adenosine methionine + 100 ml saline micro pump injection,1 day 1 time.Observation indexes:the total effective rate(1);(2)before and after treatment in patients with liver function of TBIL,AST,ALT.Results:(1)experimental group compared with the conventional group total effective rate is higher,P < 0.05;(2)treatment before liver TBIL,AST,ALT is similar in both groups,P > 0.05;Treatment after the experimental group compared with the conventional liver function TBIL,AST,ALT improved more significantly,P < 0.05.Conclusion:adenosine methionine for the treatment of viral hepatitis high blood bilirubin exactly,which can effectively improve liver function,can promote the use of clinical.

      key words:adenosine methionine.Viral hepatitis;High blood bilirubin;The effect

      病毒性肝炎高膽紅素血癥為臨床常見疾病,多以肝細胞性黃疸伴隨程度不一肝功能衰竭、肝內膽汁瘀積等,療程長且預后差[1]。本研究對腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥的效果進行分析,報告如下。

      1資料與方法

      1.1一般資料

      試驗對象:我院近2年收治的85例病毒性肝炎高膽紅素血癥患者。患者分組方法:分層隨機化法。85例患者分為常規組和試驗組兩個組別。所有患者符合病毒性肝炎診斷標準,除外血管性疾病、藥物性肝病、酒精性肝病等患者。

      42例試驗組患者中:患者中男性28例,女性14例;年齡低至19歲,高至60歲,年齡平均值(37.34±2.21)歲。病程短至5個月,長至4年,病程平均值(1.67±0.32)年;體重低至44.2kg,高至81.4kg,體重平均值(63.23±1.38)kg。

      43例常規組患者中:患者中男性28例,女性15例;年齡低至20歲,高至60歲,年齡平均值(37.57±2.13)歲。病程短至5個月,長至4年,病程平均值(1.63±0.34)年;體重低至44.2kg,高至81.2kg,體重平均值(63.13±1.36)kg。兩組患者基線資料P>0.05,研究有較強的可行性。

      1.2方法

      常規組給予常規內科治療方法治療,選用茵梔黃治療,茵梔黃30ml+250ml生理鹽水,1次/日,治療2周為1個療程。

      試 驗組(常規內科治療方法)加腺苷蛋氨酸治療。1000mg腺苷蛋氨酸+100ml生理鹽水微泵注射,1天1次,治療4周為1個療程。其他基礎治療同常規組。

      1.3觀察指標、評價標準

      觀察指標:①總有效率;②治療前和治療后患者肝功能TBIL、AST、ALT的差異。其中,顯效:患者臨床癥狀消失,體征好轉,肝功能明顯改善,改善幅度在80%以上;有效:臨床癥狀、體征好轉,肝功能有所改善,改善幅度在50%以上;無效:達不到上述標準。總有效率=顯效和有效占總例數的百分比之和[2]。

      1.4統計學處理方法

      病毒性肝炎高膽紅素血癥患者研究數據統計軟件為SPSS21.0軟件;總有效率以%表示,計數資料行χ2檢驗。肝功能TBIL、AST、ALT均統一以(`x±s)表示,計量資料行t檢驗。衡量病毒性肝炎高膽紅素血癥患者治療結果數據差異有統計學意義的標準:P<0.05。

      2結果

      2.1兩組患者總有效率相比較

      試驗組相比于常規組總有效率更高,P<0.05,如表1.

      注:與治療前相比較,#表示P<0.05;與常規組治療后相比較,*表示P<0.05

      3討論

      腺苷蛋氨酸為人體組織、體液中生理活性因子之一,它作為甲基供體(轉甲基作用)和生理性硫基化合物(如半胱氨酸,牛磺酸,谷胱甘肽和輔酶A等)的前體(轉硫基作用)參與體內重要的生化反應。在肝內,通過使質膜磷脂甲基化而調節肝臟細胞膜的流動性,而且通過轉硫基反應可以促進解毒過程中硫化產物的合成。能有效地改善肝臟的合成功能,促進肝細胞的再生,有利于肝功能的恢復腺苷蛋氨酸具有促進膽汁分泌,恢復膽道動力,促進肝細胞再生和增值,激活神經遞質合成和傳遞,抗氧化作用,解毒作用,對肝內膽汁淤積有一定防治作用。若體內缺乏腺苷蛋氨酸,則轉甲基、轉巰基通道異常,對肝細胞處理膽紅素的能力造成影響,可導致肝細胞損傷和肝內膽汁瘀積[3-4]。

      病毒性肝炎高膽紅素血癥的發生跟肝臟炎癥、肝細胞持續壞死和腺苷蛋氨酸缺乏有密切關系,導致肝細胞社區、轉化和排泄膽紅素的功能減弱,肝細胞膜結構和流動性發生改變,造成肝臟微循環障礙,甚至引發膽栓而導致肝內膽汁淤積,因此,補充外源性腺苷蛋氨酸非常重要,可維持正常磷脂比率,促進酶活性的恢復和細胞內代謝的正常化,確保肝細胞正常分泌膽紅素,加速黃疸消退,促進肝功能恢復[5-6]。

      本研究中,常規組給予茵梔黃治療;試驗組改用腺苷蛋氨酸治療。結果顯示,試驗組相比于常規組總有效率更高,肝功能TBIL、AST、ALT改善更顯著,這跟綦懷綱,牟建立,馮興華等人[7]的研究結果相似,均證實了對病毒性肝炎高膽紅素血癥患者采用腺苷蛋氨酸治療對改善患者肝功能有益。

      綜上所述,腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥的效果確切,可有效改善患者肝功能,臨床可推廣使用。

      參考文獻:

      [1] 顏炳柱,陳立艷,康嵐等.前列地爾聯合腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥療效觀察[J].胃腸病學和肝病學雜志,2011,20(9):839-841.

      [2] 王顏斌.腺苷蛋氨酸治療病毒性肝炎高膽紅素血癥108例臨床觀察[J].內蒙古中醫藥,2014,33(5):5.

      [3] 郝慶,宮姣,周林妍等.大劑量腺苷蛋氨酸治療嚴重慢性肝病所致高膽紅素血癥的療效觀察[J].實用藥物與臨床,2012,15(9):559-560.

      [4] 李太平.腺苷蛋氨酸聯合苦參堿治療病毒性肝炎高膽紅素血癥療效[J].臨床薈萃,2015,25(1):108-110.

      [5] 張永紅,肖新強,王文龍等.不同劑量腺苷蛋氨酸治療病毒性肝炎臨床觀察[J].肝臟,2013,18(9):627-628.

      [6] 陳國友,錢玉鳳.腺苷蛋氨酸治療病毒性肝炎合并高膽紅素血癥臨床肝功能指標觀察[J].中國藥物經濟學,2012,12(3):33-34

      [7] 綦懷綱,牟建立,馮興華等.腺苷蛋氨酸聯合苦參堿治療病毒性肝炎高膽紅素血癥60例[J].中國藥業,2011,20(13):50-51.

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